1Nijmegen School of Management, Radboud University, Nijmegen, The Netherlands

2Maastricht University, Maastricht, The Netherlands

3Free University Medical Centre, Amsterdam, The Netherlands

4Zuijderhoudt Consultancy, The Hague, The Netherlands

5Utrecht University, Utrecht, The Netherlands

Dr I Gremmen, Nijmegen School of Management, Radboud University, Nijmegen, The Netherlands; i.gremmen{at}fm.ru.nl

Abstract

This article concerns the issue of how an ethic of care perspective may contribute to both normative theory and mental health care policy discussions on so called Ulysses arrangements, a special type of advance directives in psychiatry. The debate on Ulysses arrangements has predominantly been waged in terms of autonomy conceived of as the right to non-intervention. On the basis of our empirical investigations into the experiences of persons directly involved with Ulysses arrangements, we argue that a care ethics perspective may broaden and deepen the debate on Ulysses arrangements, by introducing additional concepts, such as vulnerability, responsibility and mutuality, and by refining familiar concepts, such as autonomy.

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Footnotes

Funding: The research project described has been funded by The Netherlands Organisation for Scientific Research (NWO) from 1999 to 2002 with no further involvement.

Competing interests: None.

↵iWe prefer the term Ulysses “arrangement” to the terms “contract” or “statement” that may be found as well. The term “contract” may put too much emphasis on juridical aspects; “statement” has the connotation of a one-sided declaration, whereas the term “arrangement” suggests that both in the formulation and in the application others are involved. This is one reason why Ulysses arrangements may be considered a special type of advance directive. Another special characteristic is that Ulysses arrangements concern temporary situations that patients have experienced earlier.

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